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Why is the lens implant turning white?
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A recent article in the journal Cornea highlighted three cases of patients with acrylic IOLs, two of whom developed IOL calcification following DSAEK surgery. Attempts to remove the calcium with YAG laser polishing was unsuccessful, and the patients went on to have the lenses explanted.
What exactly is happening here? The prior episodes of DSAEK in two of these eyes may be coincidental, but they are certainly hard to ignore.
Opacification of acrylic IOLs after implantation is not a new idea. Glistenings of some degree seem to be common, occurring in as many as 50% of IOLs made of certain injection-molded acrylic materials. Much spirited debate has centered on the visual significance of these glistenings, but one thing is sure: We would rather patients did not have to look through them. It’s reassuring to see that a variety of lens manufacturers are seeking new lens materials and manufacturing processes that reduce the likelihood of lens opacification after lens implantation.
Among the efforts made are to lathe-cut, rather than injection-mold, new lenses. Another approach is to ship IOLs in balanced salt solution or water to pre-hydrate them before implantation. This approach is designed to avoid a change in hydration after implantation that might lead to opacification.
As a profession, we should certainly encourage manufacturers to strive for higher standards for lens materials — those that will withstand the natural hydration forces occurring after surgery and even those unexpected forces that might occur after an unplanned subsequent procedure like DSAEK.